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Managed Care Quarterly Review: Issue 1

Tips for Managing Large Claims Disputes Part 1: Pre-Litigation Avoidance and Early Litigation Strategies - Large claims disputes brought by providers against payers are on the rise. Based on previous experience with dozens...more

Medicare Exhaustion and a Brewing Circuit Split?

The U.S. Court of Appeals for the 11th Circuit issued its opinion in Tenet Healthsystem GB, Inc. v. Care Improvement Plus South Central Insurance Company on Aug. 18, setting up a brewing circuit split with the 6th Circuit’s...more

Dealing With the ‘AR Dump’: Don’t Accept the Spreadsheet

“AR dump” cases involving thousands of medical claims are on the rise. The standard playbook is for the provider to run its accounts receivable report and file a summary complaint or arbitration demand alleging the total...more

FEHBA Insurers Prevail on Subrogation and Reimbursement Rights

The U.S. Supreme Court on April 18 unanimously held that insurance carriers operating under the Federal Employees Health Benefits Act (FEHBA) may assert subrogation and reimbursement rights, pursuant to their Office of...more

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